Highly drug-resistant Vibrio cholerae harbouring blaPER-7 isolated from travellers returning to England.

Objectives: The current, seventh cholera pandemic (7PET) is notably different from the previous six, owing to its rapid global spread and increased transmission of antimicrobial resistance. The global emergence of MDR Vibrio cholerae is a public health concern. We aimed to interrogate WGS data from V. cholerae isolates referred to the UK Health Security Agency (formerly Public Health England, PHE) for the presence of blaPER-7 encoding resistance to the extended-spectrum cephalosporins.

Methods: We reviewed 161 genomes of V. cholerae isolated between 2019 and 2024 from travellers returning to the UK, screening this dataset for resistance to the extended-spectrum cephalosporins encoded by blaPER-7.

Results: We identified 3/51 V. cholerae O1 ST69 isolates and 1/110 non-O1 isolate belonging to ST555, harbouring blaPER-7 alongside mph(A), encoding azithromycin resistance. Long-read sequencing confirmed that both these genes were on a YemVchMDR1 element, that also possessed an MDR island carrying genes encoding resistance to aminoglycosides, sulphonamides and florfenicol. This element was located on an IncC plasmid in the ST69 O1 isolates but had inserted into the chromosome of the non-O1 isolate.

Conclusions: Public health institutions have the ability and responsibility to monitor the burden and spread of highly drug-resistant V. cholerae via passive surveillance, informing clinical guidance, empirical treatment and travel advice.